Food choices: Why we eat what we eat

If someone secretly filmed you for a month, capturing what you eat, where you eat and who you eat with, what would they find?

This is what scientists from the African Population and Health Research Centre (APHRC) asked residents of Makadara Sub-county in Nairobi, in a study that took place last year and this year, seeking to understand what people eat and why they eat it.

The researchers provided study participants (nearly 50 individuals and families) with cameras to take photos of what they ate, where they ate it and who they ate it with, to identify and understand the social (people) and physical factors (the food environment) that influence food choices.

The participants spent five days taking photos of their food environment: what they eat, where they eat and the people they eat with. Quality, freshness and food preparation methods were also considered as factors that inform the decisions around the types of food that people buy.

One of the participants, Henry Otieno, a 40-year-old family man who lives in Makadara with his wife (a housewife) and their 14-year-old son, gave consent for publicity.

"My wife decides what we eat. She budgets for, buys and prepares our food. We mostly eat githeri, rice and ugali," he says of his family's food choices.

"We eat the starches with green vegetables because they are cheaper than meat. We would love to eat fish and beef more often, but they are too expensive. We simply can't afford it," says Mr Otieno, the family's breadwinner, who earns a living selling second-hand clothes in the neighbourhood.

One of the key findings from the study that used a methodology called Photovoices (see side bar), was that Kenyans, especially those in urban areas, love their street food or food sold by roadside vendors. 

"This is driven by its cheapness, convenience and affordability," explains Milka Njeri, a researcher at APHRC.

Otieno, for instance, eats lunch (mostly githeri and chapati because they are “convenient and affordable”) from roadside food vendors while at work. He trusts the food vendor, whose food he has been buying for years, and says that her manner of handling food is “acceptable.”

However, he worries about the possibility of catching cholera and other sanitation-related infections.

“Given that the food is prepared by the roadside, exposed to dust and fumes from passing vehicles, it might not be that safe. But what choice do I have? I can't afford to buy food in the restaurants,” he shares.

Other participants who ate street food, also raised concerns about the state of hygiene and sanitation at the places where food is sold, and the risk of falling sick (or even getting cancer) from eating that food. There were also fears that the food is adulterated with unhealthy additives.

Apart from affordability, the study also found that one's family and the food vendors people buy from, also determine what one eats.

Steve Ndambuki, a 31-year-old programme officer at the National Council for Population and Development, who did not take part in the study, said that though he loves his githeri and other indigenous foods, his wife's and son's love for pizza and fast food, have him eating those foods more often than he likes.

The study also identified a growing popularity of kitchen gardening among Kenya’s urban folk, to supplement household food needs and as an affordable and convenient alternative to purchasing food.

“We found that some families from Makadara, for instance, grow vegetables and rear chicken for eggs and meat. This is a cheap source of healthy food for families without a stable income,” says Ms Njeri, the researcher.

Being a neighbourhood with low to middle-income residents, the findings from the study in Makadara are representative of the average Kenyan urban household, and could, therefore, be used to determine the drivers of food choices among Kenyans living in towns and cities.

The researchers said that research on food choices in urban centres is important, because about 16.5 million Kenyans live in urban setups and more keep moving from rural to urban areas in search of better economic opportunities.

As cities grow, their social and physical environments change, altering their dietary habits. In towns, diets are unhealthier -- high in trans fats, sugar and salt -- which in combination with lack of adequate physical activity, triggers a surge in lifestyle diseases such as overweight, obesity, hypertension, heart disease, diabetes and cancer.

A study in 2014 showed that overweight and obesity had increased significantly between 2008 (25 per cent) and 2014 (33 per cent). Moreover, non-communicable diseases, the lifestyle diseases mentioned above, account for 27 per cent of ill health and a third of all deaths. Predictably, cases are higher among urban dwellers than among rural folk.

“We hope that this project will contribute new evidence on ways to enhance healthier and safer dietary practices in urban centres as a key strategy to curb overweight, obesity and related non-communicable diseases,” says Ms Njeri.

At the end of the study, Otieno, who admitted that he faces challenges eating a balanced diet at all times, gathered valuable lessons that he says will significantly shape what is eaten in his household.

“Before the study, food was just food in our house. But now we understand the need to eat a balanced diet and to handle food within proper hygiene standards. After the study, we are now making efforts to eat better quality food. We feel more empowered,” he explains.

To improve the quality of food people eat generally, the researchers recommend that street food vendors, who serve a significant proportion of urban residents, be empowered to provide clean, healthy and safe food.

“Poor hygiene, environmental sanitation and food adulteration are real concerns for people as they transition from rural to urban nutrition. Enforcement of legislation can promote healthy and safe food, and help lower the risk of infection,” says Ms Njeri.

The researchers also recommend interventions targeting, not just food vendors, but also families, to ensure that the general population eats healthier.

The researchers also recommend urban farming to promote access to healthy and safe foods at lower cost. If promoted, the researchers say, urban farming has the potential to eliminate (mostly financial) obstacles that affect ability to make healthy food choices.

And given that the temptation to eat unhealthy foods in the form of treats, soars in the festive season, even for people who have been keenly watching their weight throughout the year. While most people see this as a time to let loose and binge, nutritionists warn that this choice comes with a heavy price. Take-home from Ms Njeri? Eat everything in moderation and be physically active this holiday season.

“Make healthy choices in the food you buy and consume. Emphasise on whole foods and less refined foods, fast foods, sugary foods and sugar-sweetened beverages,” Ms Njeri advises.

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What determines your food choices?

Daniel Mbugua, 26, PR practitioner

My family insists on healthy food at home, but I can't resist nyama choma when I'm hanging out with my friends. Eating junk food is unhealthy, and it also feels like a betrayal of my family's ideals, but this sentiment is not shared by members of my social group, who prefer eating out, and hence influence my eating habits in that direction.

Daniel Ogeta, 23, is a bachelor in Nairobi’s Umoja estate

I don't have a stable job or income, so what I eat is determined by whether I have money. When I do, I buy food and cook at home. That's the only time I eat a balanced diet. When I don’t have enough money, I eat whatever else is available. I mostly buy githeri and fry it at home or eat ugali and greens at kiosks in the neighbourhood, which are affordable.

Maureen Leina, student in Nairobi

My cravings determine what I eat, so I am more likely to eat snacks than eat a whole meal. I also have a busy schedule in school which does not allow time to prepare a proper meal, so fast foods from restaurants are my mainstay. Meat and meat products also feature heavily on my menu. I know it is unhealthy, but isn't life too short to agonise over everything I eat?

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Photovoices: Doing research using photos

Photovoices is a participatory research method that allows community members to capture issues affecting them through photography.

“Participants are provided with cameras to take photos of life around them. They later exhibit the photos to audiences and discuss their concerns and challenges and suitable remedies with researchers and policymakers. This way, the community acts as a catalyst for social change,” the researcher explains.

Photovoice is part of a diverse research project on drivers of food choices in urban cities. It makes it possible to engage marginalised or overlooked populations, based on the premise that everyone has something important to contribute to the development of societies.

Photovoice also challenges traditional views of what counts as knowledge and who creates knowledge. The photographers are the experts of their own lives and their photographs serve as a visual “voice” that tell difficult stories in a meaningful way to shape narratives.